Optics has had a significant impact in the development and implementation of medical acoustical imaging. Principles of optical systems theory and optic instrumentation have played an important role in the conception, design, and development in new ultrasonics research tools for diagnostic imaging and tissue characterization; this is ex-emplified in the paper with a few acoustic imaging systems. A potential imaging system whose success relies on the interface between the optical subsystem and the acoustic subsystem is described. This system would have the advantage of operational flexibility and electronic simplicity. The present obstacles and possible solutions are discussed.